Psychotherapy Services

Psychotherapy Services Table of Contents Regulations and Targeted Probe and Educate Resources Medicare Regulations CMS TPE Resources NGS Resources Psychotherapy Treatment Plans Required Treatment Plan Components [...]

Psychotherapy Services

Billing Cardiac Rehabilitation Session and Session Limitations

Billing Cardiac Rehabilitation Session and Session Limitations CR sessions are limited to a maximum of two one-hour sessions per day for up to 36 sessions up to 36 weeks with the option of an additional 36 sessions over an extended [...]

Cardiac Rehabilitation and Intensive Cardiac Rehabilitation

Cardiac Rehabilitation and Intensive Cardiac Rehabilitation Medicare Part B pays for CR and ICR programs and related items/services. Specific criteria must be met by the Medicare beneficiary, the cardiac rehabilitation program itself, the [...]

Pulmonary Rehabilitation

Pulmonary Rehabilitation Effective 1/1/2010, Medicare Part B pays for PR if specific criteria are met by the Medicare beneficiary, the PR program itself, the setting in which it is administered and the physician administering the program, as [...]

Related Content

Related Content Centers for Medicare & Medicaid Services (CMS) Internet-Only Manual (IOM) Publication 100-04, Medicare Claims Processing Manual, Chapter 32, Cardiac Rehabilitation (CR) Programs, Intensive Cardiac Rehabilitation (ICR), [...]

MLN Connects® Newsletter: September 5, 2024

MLN Connects® Newsletter: September 5, 2024 News Osteogenesis Stimulators: Prior Authorization Requirements Suspended Hospice Benefit: Expanding Prepayment Review in 4 States Skilled Nursing Facility Advance Beneficiary Notice: Revised [...]

LCD and Article Updates for August/September 2024

LCD and Article Updates for August/September 2024 Local Coverage Determinations Facet Joint Interventions for Pain Management L35936 Effective 8/1/2024 - Updated "Coverage Indications, Limitations and/or Medical Necessity" with the [...]

Telligen QIN-QIO Hosting Chronic Kidney Disease Topics with National Kidney Foundation

Telligen QIN-QIO Hosting Chronic Kidney Disease Topics with National Kidney Foundation Chronic kidney disease (CKD) affects more than 1 in 7 U.S. adults—an estimated 37 million Americans. For Americans with diabetes or high blood pressure—the [...]

Therapy Timeframes

Common Working File (CWF) Host Dark Days for October 2024 Release

Common Working File Host Dark Days for October 2024 Release For the upcoming October 2024 Release: For Production, CWF will be observing the Gray Day on Thursday, 10/3/2024, and Dark Days starting Friday, 10/4/2024 through Sunday, 10/6/2024 [...]

Psychotherapy Services and Targeted Probe and Educate

Psychotherapy Services and Targeted Probe and Educate We’ve added a new section to our website for Psychotherapy Services. Visit this page for informative instruction about completing a psychotherapy treatment plan, the required components to [...]

MBI Lookup

MBI Lookup The MBI Lookup should be used when you have attempted to obtain a copy of the patient’s Medicare card or MBI from the patient or the patient’s caregiver. The MBI Lookup will allow you to search for and receive a patient’s MBI. [...]

Expected Timeframes for Therapy Services

Expected Timeframes for Therapy Services CMS and CPT guidelines for provider time spent and documented on therapy services may vary, depending on the definition of the service and the context in which it is performed. View our Therapy [...]

Health Professional Shortage Area

Health Professional Shortage Area Table of Contents What is a HPSA Eligible Providers HPSA Eligibility and Designation Claim Coding Requirements and Payment Locating a HPSA Designation on HRSA Website What Is a HPSA? A HPSA is an [...]

CMS Incentive Payment Information

CMS Incentive Payment Information Program Information Quarterly and annually, CMS issues special incentive payments to EPs that participate in the following incentive programs. Providers are welcome to use the information below to [...]

RuralServ

NGS RuralServ Our rural health providers face unique challenges in delivering quality of care to Medicare beneficiaries and in the associated administrative functions to file claims to Medicare. The RuralServ section of our website provides [...]

Introduction to Chiropractic Services

Medicare Coverage of Chiropractic Services Introduction to Chiropractic Services A chiropractor must be licensed or legally authorized to furnish chiropractic services by the state or jurisdiction in which the services are furnished. In [...]

Chiropractic Coverage

Medicare Coverage of Chiropractic Services Chiropractic Coverage Medicare pays chiropractors for spinal manipulation CPT codes 98940–98942, when these services are reasonably and medically necessary and meet all Medicare coverage guidelines [...]

Maintenance Care for Chiropractic Services

Medicare Coverage of Chiropractic Services Maintenance Care for Chiropractic Services Medicare coverage for chiropractic services extends only to treatment by means of manual manipulation of the spine to correct a subluxation, provided such [...]

Medical Review Audits

Medicare Coverage of Chiropractic Services Medical Review Audits Medicare contractors perform medical review audits to ensure Medicare is paying providers for appropriately covered Medicare services. Medical review examines documentation [...]

Modifiers

Medicare Coverage of Chiropractic Services Modifiers AT Modifier Used to indicate that the covered services billed are for active corrective treatment and the provider’s documentation supports medical necessity and Medicare coverage [...]

Proper Billing for Acupuncture

Medicare Coverage of Chiropractic Services Proper Billing for Acupuncture Decision Memo for Acupuncture for Chronic Low Back Pain (CAG-00452N) Reviewed 9/11/2024

Limited Coverage for Services Ordered or Furnished By a Chiropractor

Limited Coverage for Services Ordered or Furnished By a Chiropractor This article is to remind chiropractors and facilities that X-rays and other diagnostic tests are statutorily excluded services when ordered or furnished by a chiropractor. [...]

Documentation to Support Spinal Manipulation for CPT Code 98942

Documentation to Support Spinal Manipulation for CPT Code 98942 It is not uncommon for chiropractic doctors to perform a full-spine or multi-level manipulation, even when the symptoms or diagnosis reflect a single region. This is a matter of [...]

Advance Beneficiary Notice of Noncoverage Liability

Medicare Coverage of Chiropractic Services Advance Beneficiary Notice of Noncoverage Liability The Advance Beneficiary Notice of Noncoverage (ABN), Form CMS-R-131, is a standardized notice that a health care provider/supplier or his/her [...]

Chiropractic Resources

Medicare Coverage of Chiropractic Services Chiropractic Resources Code of Federal Regulations Code of Federal Regulations (Annual Edition) web page 42 CFR Section 410.21 describes limitations on services of a chiropractor 42 CFR [...]

Original Medicare First Level of Appeal Tips Sheet for Medicare Providers

Original Medicare First Level of Appeal Tips Sheet for Medicare Providers If you disagree with Medicare’s claim determination, you may appeal. However, please follow these important tips before you submit a first level of appeal [...]

Coverage of Rural Air Ambulance Services

Coverage of Rural Air Ambulance Services Section 415 of the Medicare Modernization Act of 2003 provides coverage for rural air ambulance services that are reasonable and necessary and ordered by qualified personnel. Medicare considers the [...]

New York State Ambulance Services in Rural Areas (for JK providers only)

New York State Ambulance Services in Rural Areas NYS has unique requirements for the payment of paramedic intercept services when an ambulance company can provide only BLS services. Paramedic intercept services can be approved in counties and [...]

PECOS Starter Guide

PECOS Starter Guide Follow the steps outlined below to assist you and your staff with the PECOS processes. Table of Contents New/Initial Enrollee Revalidation Return for Corrections Change of Information Submit Pending Application [...]

General Information

General Information Original Medicare does not normally cover routine vision services, such as eyeglasses and eye exams. Medicare may cover some vision costs if associated with other covered expenses (that is, Medicare may cover some vision [...]

Provider Qualifications

Provider Qualifications Definition Ophthalmologist An ophthalmologist is a Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) who has completed medical school and an ophthalmology residency that specialized in eye and [...]

Local Coverage Determinations

Local Coverage Determinations Table of Contents Cataract Extraction LCD L33558 Corneal Pachymetry LCD L33630 Coding Guidelines Ophthalmic Biometry for Intraocular Lens Power Calculation LCD L33621 A-Scan Ultrasound Ophthalmic [...]

National Coverage Determinations

National Coverage Determinations Table of Contents Hydrophilic Contact Lens for Corneal Bandage Photodynamic Therapy Ocular Photodynamic Therapy Photosensitive Drugs Verteporfin Hydrophilic Contact Lenses Scleral Shell Intraocular [...]

Limitation of Liability (Advance Beneficiary Notice)

Limitation of Liability (Advance Beneficiary Notice) Services denied as not reasonable and medically necessary, under Section 1862(a) (1) of the Social Security Act, are subject to the Limitation of Liability (ABN) provision. The ABN is a [...]

Glaucoma Screening ‒ Preventive Services Coverage

Glaucoma Screening ‒ Preventive Services Coverage Medicare provides coverage of an annual glaucoma screening for beneficiaries in at least one of the following high-risk groups: Individuals with diabetes mellitus; Individuals with a family [...]